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HomeMy WebLinkAbout1015 Craig Ave - BuildingWed,10 /4/2006 0:4 PM yOF pORT4 Q I stibrsorD To City of Fart Angeles City Engineer 321 E Fi th Street P 0 Bo) 1150 Port Angeles, Washington 98362 PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION NOTE. All questions must be answered for waste to be approved. 1 Generator Information Company Name. c ,S IA Mailing Address: PS1_ I (2)-35 a.ox 60 F A E®9 59 3 Phone: ©1 I5 G97. 572-5 Project Name xtsri/4, ✓LRst JT IA( Co A✓A6 Project Location /0/ RAI Ga At /r 2 Other Contacts (if applicable) Consulting Firm: 3GI,QTe S Contact: 1-1. onA LI( Phone 3 &0 f `7 OSc' f Contractor Name: (,v &S Contact: L- Phone 6a S 11 Laboratory- N (IL t_4c7 cam_ i fs S N L, Contact: /,a n) U .cgs'', k' J Phone. 0-06 c I aC tO DA a 7- 4 5 Phone (360) 417 -4803 FAX. (360) 417 -4709 City of Port Angeles Landfill Waste Disposal Application Page 1 Wed,10 /4/20 0:4 PM 3 Source of Waste. Check the appropriate box below and briefly describe the project, process, and /or cleanup that will or has produced the waste requiring disposal Include the gasoline service station number (if applicable) CERCLA/MTCA Remediation Independent Remedial Action Unused Chemical Product Spill gk, SZ! Mc. G .l• rG 0 4 Waste Material Composition (check all that apply and include percent of total) Soil Concrete /Asphalt Preserved Wood Coal Ash Wood Ash NOTE. Total must equal 100% Agency Contact: UST Removal Other Source. 0A6 S Foundry Slag Dredge Sediments Debris Other (list) 5 Waste Material Contaminants (check all that apply) Gasoline Metals Diesel Solvents Heating Oil PCBs Unused Motor Oil Used Motor Oil/Waste Oil Other 7 kr' Other Petroleum Product TLC_ p, p Unknown NOTE. Supply any MSDS information with application if available City of Port Angeles Landfill Waste Disposal Application Page 2 1 Wed,10/4/2006 0:4 PM 6 Estimated Quantity of Waste for Disposal Other NOTE. Estimated quantity for disposal must be within 20% of the quantity actually disposed (10% for projects over 7,500 tons or 5 000 cubic yards 7 Frequency of Disposal* 8 Waste Sampling Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling will vary with the type and form of the waste Check the appropriate box and briefly describe how and where the waste was sampled Include site maps with sampling locations if possible Number of COMPOSITE samples ,1 number of discrete samples per composite Number of DISCRETE samples A )6 O ry NA4_ (u os r 4Lk krr, r 0 NOTE 1 NOTE 2: (tJ Cubic yards Tons (estimate both) Drums Tons (estimate both) One time 0 -25 25 100 101 500 5011 1000 1001 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards Monthly One composite sample shall discrete samples. Annual Other Unless prior approval has been granted by Port Angeles the following sampling frequency will be used 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards contain a minimum of three /maximum of five City of Port Angeles Landfill Waste Disposal Application Page 3 Wed,10 /4/2006 0:4 PM 9 Waste Analysis The `Dangerous Waste Regulations (WAC 173 -303) shall be utilized to determine the appropriate analytical requirements for waste characterization Ecology Publication. #91 -30 (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils shall also be used to characterize petroleum contaminated soils from UST releases Submit all laboratory analytical results, QA/QC data, and Chain of Custody sheets along with this application. (NOTE. The laboratory must be accredited by the Washington State Department of Ecology a) List all analytical test methods used 4t 311/ Y 43 b) Provide a narrative as to why the above analytical methods were selected I/A. Tca h Tlfr- c,36)vLf1 rhAA A Psi t r t, of L f) A2,4sff.a1 PA /AY. NOTE. Additional sheets attached YES NO 10 Soil Classification (**FOR PETROLEUM CONTAMINATED SOILS ONLY**) Based on the analytical data and Ecology Publication #91 -30 the soil classification is. (check one) Class 1 Class 2 Class 3 Class 4 Calculated Hazard Index 11 Dangerous Waste Affidavit: Based on a review of the analytical test results, site history and the applicable regulations, this waste is classified as. (check one) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles Landfill Waste Disposal Application Page 4 Wed,10/4/2006 0:4 PM 12 Certificati( n. We THE UNDERSIGNED certify that this application is true to the best of our knowledge All information provided is correct and the enclosed analytical results represent the proposed waste ma rial tc7the best of our abilities. West enerator Stiig+fate Printed Nanie A sccc.li At" 5 J) Company Date City of Port Angeles Approval. tLeda nN City Engineer /D --0 7 Date /2 °7 Approval Expiration Date U City of Port Angeles Landfill Waste Disposal Application Page 5 btr 25 2807 8 46AM NVL LABORATORIES INc NVL Laboratories, Inc. 4708 Aurora Ave, N. Seattle, WA 98103 Tel: 206.547.0100, Fax: 206.634.1936 www.nvltabs.com Client Zenovia Associates, Inc. Address: 301 E. 6th St. Suite 1 Part Angeles, WA 98362 Attention. Mr Scott Headrick Project Location. 1015 Craig Ave Port Angeles, WA Lab ID 27089311 9/17-A Sampled by Client Analyzed by Tanveer Khan Client Sample NO 2993 AIHA tH 101861 Analysis Report WA DOE C1785 Toxicity Characteristic Leaching Procedure Lead (Pb) Date Analyzed: 09/25/2007 RL mg/ L 0.5 Results in mq /L 3.3 mg/ L Milligrams per liter ppm parts per million Note Method QC results are acceptable unless stated otherwise. Unless otherwise indicated, the condition of all samples was accentahls at tirna of raraird. DRAFT ACCRIDATEDI LADORA!O1W Batch 2713549.00 Matrix; Bulk Method: EPA 1311/70006 Client Project 07223 Date Received: 09/18/2007 Samples Received: 1 Samples Analyzed: 1 Results in ppm 3.3 RL Reporting Limit 'C' Below the reporting Limit SEP -25 -2007 07 16P FROM Date 9/25 /07 Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 notthwestasbestosconsultants @cablespeed. corn "fob Site: 1015 Craig Ave E. Port 4ngeles, WA 98362 Owner: Irene Smith Contacts: Zenovic and Associates Tracy Gudgel, PE Score; Headrick 301 E. 6th St. Suite #1 Port Angeles, WA 98362 Subject: Demolition Ipcpector: Bob Witheridge AHEPA Building inspector Management Planner WAMDA 0042- 10270601 Expires 10/27/07 TO 13604170514 P 3 SEP -25 -2007 07 17P FROM Scope of work 1) Building survey and inspection to inspect for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Scott Headrick of Zenovic and Associates results of testing from Northern Industrial Hygiene, Inc. Inspection Report Requested by Scott Headrick of Zenovic and Associates. Single story garage and connected storage building had wood and metal siding on wood and cement foundation. Roof was a plastic and composition. Approx. 1534 sq. ft. The following sample was taken and sent to lab. Sample #1. Roofing material. Summary of Inspection Lab reports as follows: $ample #1. Roofing material. No asbestos detected. See lab attached results: TO 13604170514 P 4 All asbestos containing building materials with a reading of greater than 1% is considered a hazardous material if disturbed. Removal of any hazardous materials can be abated by the owner or a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency During building demolition, it is possible that additional suspect asbestos containing building material (ACBM) may be found with in a wall, floor, ceiling or other areas not accessible at the time of the survey Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. Thank you, IDCLk3 Bob Witheridge, E.P.M. SffP -25 -2007 07 17P FROM ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360- 385 -0584 nc rthwestasbestosconsultants @cablespeed. corn To Northern Indubtrial Hygiene, Inc. altel 9/18i'07 Job Site: 1015 Craig Ave E. Port Angeles, WA 98362 Irene Smith Contacts: Zenovic and Associates Tracy Gudgel, PE Scott Headrick 301 E. 6th St. Suite #1 Port Angeles, WA 98362 Samnle #1. Roofing material. Inspector Bob Witheridge AHERIA Building inspector Management Planner WAMOA 0042- 10270601 Expires 10/27/07 Please call with results when completed. See attachment. Thank you, ofkomfew Bob Witheridge, E.F.M. TO 13604170514 P 5 SEP -25 -2007 07 17P FROM Northwest Asbestos Consultants 406 Reed Street Port Townsend, WA 98368 Pit ect Location: 1015 Craig Avenue E Pod Angeles. WA Client Sample Number I Sample Description: Roofing Material Sample Location: None Given Sample Comments: Chunks of black asphalt Asbestos Fibrous Components: Non Asbestos Fibrous Components: No Asbestos Detected 5% Cellulose Sampled by Bob Witheridge Received by Rachel Mahlon Reviewed by Jude Cummins Bulk Asbestos Analysis Report 9/1712007 9/2412007 9/25/2007 f 215 SW 153rd Street Burien, WA 98166 i OFFICE- (206) 988 -1746 FAX. (208) 988 -1978 EMAIL nihinc @escheton.com NYLAP# 200511-0 NIH Batch Number. 07 -00918 Client Job Number 'rum Around Tine: 5 Day C Samples Analyzed: 1 TO 13604170514 P 6 Lab Sample Number 07 00918.0001 Checked if Sample Not Analyzed 0 Non Fibrous Components: 15% Aggregate 80% Asphalt Filler and Binder i o Jude Cummings, Laboratory Manager SP -25 -2007 07 17P FROM TO 13604170514 P 7 O; V] o, o: o• O: 4; c. 0. 6. o:o:C :0:0:0 :o :0:0:0:0:0;0:0:0:0:0:0:0:0: 0:0:O:o10 :o:J:O :o :o:J:o :o. :o:O[0:0:0:0:0:0 :O n:O:C:O:c :O WASHINGTON ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS Bob Witheridge Participated in the EPA AHERA INSPECTOR, MANAGEMENT PLANNER Reffeshef Course-offered by the- WASHINGTON- ASSOCIATION of MAINTENANCE ani OPERATIONS ADMINISTRATORS The full day training program covered all topics specified in the Model Accreditation Plan under Section 206 of Title 11 of TSCA The course was taken on October 27, 2006 in Silverdale, Washington Certificate #1 Expiration October 27, 2007 Colin MacRae Course Administrator 2714 228th St. SE, Bothell, WA 98021 1 (425) 456 -4568 o ter hosimaz i wr.,,[ 'dij1 5 LOOZ 0 Z d3S G3A1j034 b 1.-tA cZ) i J7 L o i m u,AS D a-)) M o e ,Prc3 e v -1-o Coo mk∎ h o -e, p mn 1% --i a h Nev. BUILDING PERMIT APPLICATIQN s ow hear hear hvsS, av�d. are- ouf of s e- 'I Fill out COMPLETELY and in INK. Your application, prescripts W form, plans, specs, and a 8 V2" x 11" site plan MUST BE accepted for review (360) 417 -4815 FAX (360) -4711 oc\ 11`1 07 itch d ex- ca 11 0,00 QQ y i Residential projects: sub two sets of plans Q hmr Sv`C q t p \6lCommercial projects. s mit three sets of plans 4, Applicant or Agent Ktc L,,,(L(/�-�v1sa� AGENT tS C4 II Owner 62-0 S_S ,,..'iT W c Phone P 7 `(y �.e�< l,U�s�, r�3 3/ Contractor/Engineer T 13 n State License Contractor/Engineer's Address PROJECT ADDRESS (O (5 ('vn 1 �1 v LEGAL DESCRIPTION Lot: Block. CLALLAM COUNTY PARCEL NUMBER. Owner's Address TYPE OF WORK Residential 0 New Constr 0 Re -roof Multi- family Addition ❑o Move Commercial Remodel ,Demolition Repair Sign o Other BRIEF DESCRIPTION OF THE PROJECT e Stove Garage Deck A P a 9'�` Existing Structure(s) basement Sq. Ft. Proposed Structure(s) basement Sq Ft. k t Cif Ord 1S' floor Sq. Ft. 1" floor Sq. Ft. h9 2 floor Sq. Ft. 2 floor Sq. Ft. He S i�hk 3` floor Sq. Ft. 3` floor Sq Ft. �e''9�ny ac, Accessory Structures Sq Ft. Accessory Structures Sq. Ft. lutes eyt. Existing Structure(s) TOTAL Sq. Ft. Proposed Structure(s) TOTAL Sq. Ft.7 key( TOTAL of existing proposed structures Sq Ft. a d 4 '1% LOT COVERAGE Maximum Height of Proposed Structure(s) Ft. S f S� Lot size Sq Ft. I/ <ey `M 64 s Existing Structure(s) Sq. Ft. Footprint Me C o Proposed Structure(s) Sq. t. Footpri c t t5 TOTAL Structure(s) Sq. Ft. Footpri it PIP PIP cti Total Lot Coverage (Divide Total Structure(s) Sq. Ft. Footprint by Lot Size Sq Ft.) h VALUATION OF RUCTION In all cases. a valuation amount must be entered by the applicant. This figure will be reviewed and may be I by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 'y for assistance. PLAN CHECK FEE. The plan checl fee must be paid at the time the building permit application is submitted. All other permit fees are due at the time of permit lance. EXPIRATION OF PLAN REVIEW An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing unless such application has been pursued in good faith or a permit has been issued, except that the building official is authorized to grant one or more extensions of time for additional periods not exceeding 180 days (90 days for commercial extension projects) each. The shall be requested in writing and justifiable cause demonstrated. (IRC /IBC 2006 105.3.2) I hereby certify that I have read and examined this applicati n and know the same to be true and correct. 1 am authorized to apply for this permit and understand that it is my respon ilit to,deterV7ine alit permits are required, and that I must obtain such permits prior to work. I Uri t� H� ui v� �.ti��� a C-e Lt. COMMERCIAL/RESIDENTIAL. Occupancy Group. T•\FORMS\BUILDING DIVISION \BldgPermitAppl. 2006 CODE backup.wpd CPI I sq./ 11 SIZE/VALUATION irj3'1 h A SF /SF n /a SF /SF SF /SF TOTAL VALUATION Occupant Load. Construcfion Type: Are you planning to install a lawn sprinkler system? Date q "(0 o Applicant Subdivision. 1)100 Sc 1 Expires Phone ZONING FOR OFFICIAL USE ONLY Date Rec. 9 I 0 0 Permit it C) 9 ate Approved: ate Issue e Lt o h t 0 3 6 0 q 1 2 0 1 3 .3C,c)- C YO kc?c? hc.o 7v -C7y?j o-oo 9 0 4 4 Craig Ave Z:71:1(4• b 3\12)rf\ Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Qty Unit Permit Fee Total Plan Check Total Grand Total Charge CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 07 00001046 190376 1015 CRAIG AVE 06 30 14 5 4 0265 0000 IRENE S SMITH DEMOLITION RS9 RESDNTL SINGLE FAMILY 10000 Owner Contractor IRENE S SMITH OWNER PO BOX 944 FORKS WF, 983310944 (360) 640 8530 Structure Information COO 000 DEMOLISH 1700 SQ FT GARAGE /SHOP Permit DEMOLITION Additional desc 1 1700 SF GARAGE /SHOP Permit pin number 110767 Permit Fee 50 00 Plan Check Fee 00 Issue Date 10/01/07 Valuation 0 Expiration Date 3/29/08 Per Extension BASE FEE 50 00 Special Notes and Comments The Fire Department has reviewed the project application and has no comments 09/14/2007 03 00 PM 11 SROBERDS No land use issues noted MAINTAIN CLEARANCES FROM SERVICE WIRES Any modifications to the City s electrical facilities will be at the customer s expense Waste Disposal Application is required for debris taken to the transfer station 09/18/2007 08 21 AM I RVESS Fee summary Charged Paid Credited 50 00 50 00 00 00 00 00 00 50 00 00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of constructs Gr r t-/6 for or Authoriz gent l i T \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] Date Date 10/01/07 Due Signature of Owner (if owner is builder) Date 00 00 00 kio\edt\ CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS CALL 417 -4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORE BEFORE INSPECTED AND ACCEPTED POST PERMIT IN A CONSPICUOUS LOCATION O KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE I ACCEPTED COMMENTS FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL /HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL ROUGH -IN HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY ELECTRICAL LIGHT DEPT 417 -4735 TAPolicies\ 102 15 building permit inspection record05 wpd [1/4/2001) BUILDING PERMIT INSPECTION RECORD COED V YES NO MANUFACTURED HOMES FOOTING SLAB I BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT it's SEPA. PARKING /LIGHTING ESA. LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 (1 PW /ENGINEERING FIRE 417 -4653 I I I FIRE DEPT I PLANNING DEPT 417 -4750 I .I I 1 1 1 1 1 I I PLANNING DEPT I BUILDING 417-4815 I 111 ;01(0 I l l! I) I I BUILDING FINAL DATE ACCEPTED BY. FINAL ELECTRICAL LIGHT DEPT DATE ACCEPTED BY. 0 DATE ACCEPTED I YES NO October 1 2007 Irene S Smith PSL 1005 Box 50 FPO AE09593 Encl. WDA 07 -45 T NG LES W A S H I N G T O N U S A Copy Claudia Stromski West Excavation Bldg N:\P W KS\ENGINEER \W DAPPLIC\07 -45 File: Landfill Solid Waste Di.6osal Applications Public We rks Utilities Department RE. Port Angeles Landfill Transfer Waste Disposal Application, WDA 07 -45 Building demolition at garage at 1015 Craig Ave, Port Angeles,WA We have received /our application for disposal of building demolition debris from the referenced site and reviewed the testing results for lead and asbestos content. Based on the testing results the debris appears 'to be acceptable for disposal at the transfer station. A copy of your approved application is atta;hed. This approved application must be shown to the transfer station scale attendant at the tutie of disposal. Please be advised that this disposal application is only for the materials and quantities listed in the application. T.'Laterials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you lave questions Very truly yours, Stephen Sperr P.F. City Engineer Phone 360- 417 -4805 Fax 360- 417 -4542 Website www cityofpa.us Email publicworks @cityofpa.us 321 East Fifth StreE t PO Box 1150 Port Angeles, WA 98362 -0217